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Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2000 May;59(5):331–337. doi: 10.1136/ard.59.5.331

Factors that modify the association between knee pain and mobility limitation in older women: the Women's Health and Aging Study

S Lamb 1, J Guralnik 1, D Buchner 1, L Ferrucci 1, M Hochberg 1, E Simonsick 1, L Fried 1
PMCID: PMC1753141  PMID: 10784513

Abstract

OBJECTIVE—To investigate the influence of pain severity, knee extensor muscle weakness, obesity, depression, and activity on the association between recent knee pain and limitation of usual and fast paced walking, and ability to rise from a chair.
METHODS—A cross sectional analysis of 769 older women (mean age 77.8, range 65-101) with physical disability, but no severe cognitive impairment. Severity of knee pain in the past month was classified as none, moderate, or severe. Mobility was measured using timed performance tests.
RESULTS—The prevalence of recent knee pain was 53% (408/769). One third of the women with pain reported it to be severe. In general, knee pain was only significantly associated with limited mobility if severe. Obesity, activity and, to a lesser extent, depression intensified the effects of pain. Knee extensor weakness did not. Obesity was a distinctive risk factor in that it substantially increased the risk of mobility limitation, but only in women with pain. In women who had severe pain, activity (walking more than three city blocks in the past week) increased the risk of walking disability more than inactivity. Depression had a minor, but statistically significant effect on walking ability, but not the ability to rise from a chair.
CONCLUSION—In older women with recent knee pain, a high pain severity score, obesity, and activity are important factors that increase the risk of mobility limitation.



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Selected References

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  1. Bassey E. J., Fiatarone M. A., O'Neill E. F., Kelly M., Evans W. J., Lipsitz L. A. Leg extensor power and functional performance in very old men and women. Clin Sci (Lond) 1992 Mar;82(3):321–327. doi: 10.1042/cs0820321. [DOI] [PubMed] [Google Scholar]
  2. Bellamy N., Buchanan W. W., Goldsmith C. H., Campbell J., Stitt L. W. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988 Dec;15(12):1833–1840. [PubMed] [Google Scholar]
  3. Brattberg G., Thorslund M., Wikman A. The prevalence of pain in a general population. The results of a postal survey in a county of Sweden. Pain. 1989 May;37(2):215–222. doi: 10.1016/0304-3959(89)90133-4. [DOI] [PubMed] [Google Scholar]
  4. Brown M., Sinacore D. R., Host H. H. The relationship of strength to function in the older adult. J Gerontol A Biol Sci Med Sci. 1995 Nov;50(Spec No):55–59. doi: 10.1093/gerona/50a.special_issue.55. [DOI] [PubMed] [Google Scholar]
  5. Buchner D. M., Wagner E. H. Preventing frail health. Clin Geriatr Med. 1992 Feb;8(1):1–17. [PubMed] [Google Scholar]
  6. Chang R. W., Dunlop D., Gibbs J., Hughes S. The determinants of walking velocity in the elderly. An evaluation using regression trees. Arthritis Rheum. 1995 Mar;38(3):343–350. doi: 10.1002/art.1780380308. [DOI] [PubMed] [Google Scholar]
  7. Crook J., Rideout E., Browne G. The prevalence of pain complaints in a general population. Pain. 1984 Mar;18(3):299–314. doi: 10.1016/0304-3959(84)90824-8. [DOI] [PubMed] [Google Scholar]
  8. Dekker J., Tola P., Aufdemkampe G., Winckers M. Negative affect, pain and disability in osteoarthritis patients: the mediating role of muscle weakness. Behav Res Ther. 1993 Feb;31(2):203–206. doi: 10.1016/0005-7967(93)90073-4. [DOI] [PubMed] [Google Scholar]
  9. Ettinger W. H., Jr, Burns R., Messier S. P., Applegate W., Rejeski W. J., Morgan T., Shumaker S., Berry M. J., O'Toole M., Monu J. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST). JAMA. 1997 Jan 1;277(1):25–31. [PubMed] [Google Scholar]
  10. Ettinger W. H., Jr, Fried L. P., Harris T., Shemanski L., Schulz R., Robbins J. Self-reported causes of physical disability in older people: the Cardiovascular Health Study. CHS Collaborative Research Group. J Am Geriatr Soc. 1994 Oct;42(10):1035–1044. doi: 10.1111/j.1532-5415.1994.tb06206.x. [DOI] [PubMed] [Google Scholar]
  11. Ferrucci L., Guralnik J. M., Buchner D., Kasper J., Lamb S. E., Simonsick E. M., Corti M. C., Bandeen-Roche K., Fried L. P. Departures from linearity in the relationship between measures of muscular strength and physical performance of the lower extremities: the Women's Health and Aging Study. J Gerontol A Biol Sci Med Sci. 1997 Sep;52(5):M275–M285. doi: 10.1093/gerona/52a.5.m275. [DOI] [PubMed] [Google Scholar]
  12. Ferrucci L., Guralnik J. M., Salive M. E., Fried L. P., Bandeen-Roche K., Brock D. B., Simonsick E. M., Corti M. C., Zeger S. L. Effect of age and severity of disability on short-term variation in walking speed: the Women's Health and Aging Study. J Clin Epidemiol. 1996 Oct;49(10):1089–1096. doi: 10.1016/0895-4356(96)00231-4. [DOI] [PubMed] [Google Scholar]
  13. Fiatarone M. A., O'Neill E. F., Ryan N. D., Clements K. M., Solares G. R., Nelson M. E., Roberts S. B., Kehayias J. J., Lipsitz L. A., Evans W. J. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med. 1994 Jun 23;330(25):1769–1775. doi: 10.1056/NEJM199406233302501. [DOI] [PubMed] [Google Scholar]
  14. Folstein M. F., Folstein S. E., McHugh P. R. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189–198. doi: 10.1016/0022-3956(75)90026-6. [DOI] [PubMed] [Google Scholar]
  15. Fried L. P., Ettinger W. H., Lind B., Newman A. B., Gardin J. Physical disability in older adults: a physiological approach. Cardiovascular Health Study Research Group. J Clin Epidemiol. 1994 Jul;47(7):747–760. doi: 10.1016/0895-4356(94)90172-4. [DOI] [PubMed] [Google Scholar]
  16. Guralnik J. M., Ferrucci L., Simonsick E. M., Salive M. E., Wallace R. B. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995 Mar 2;332(9):556–561. doi: 10.1056/NEJM199503023320902. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Keefe F. J., Caldwell D. S., Queen K., Gil K. M., Martinez S., Crisson J. E., Ogden W., Nunley J. Osteoarthritic knee pain: a behavioral analysis. Pain. 1987 Mar;28(3):309–321. doi: 10.1016/0304-3959(87)90066-2. [DOI] [PubMed] [Google Scholar]
  18. Kovar P. A., Allegrante J. P., MacKenzie C. R., Peterson M. G., Gutin B., Charlson M. E. Supervised fitness walking in patients with osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med. 1992 Apr 1;116(7):529–534. doi: 10.7326/0003-4819-116-7-529. [DOI] [PubMed] [Google Scholar]
  19. Leach R. E., Baumgard S., Broom J. Obesity: its relationship to osteoarthritis of the knee. Clin Orthop Relat Res. 1973 Jun;(93):271–273. doi: 10.1097/00003086-197306000-00030. [DOI] [PubMed] [Google Scholar]
  20. Lichtenstein M. J., Dhanda R., Cornell J. E., Escalante A., Hazuda H. P. Disaggregating pain and its effect on physical functional limitations. J Gerontol A Biol Sci Med Sci. 1998 Sep;53(5):M361–M371. doi: 10.1093/gerona/53a.5.m361. [DOI] [PubMed] [Google Scholar]
  21. Magni G., Caldieron C., Rigatti-Luchini S., Merskey H. Chronic musculoskeletal pain and depressive symptoms in the general population. An analysis of the 1st National Health and Nutrition Examination Survey data. Pain. 1990 Dec;43(3):299–307. doi: 10.1016/0304-3959(90)90027-B. [DOI] [PubMed] [Google Scholar]
  22. McAlindon T. E., Cooper C., Kirwan J. R., Dieppe P. A. Determinants of disability in osteoarthritis of the knee. Ann Rheum Dis. 1993 Apr;52(4):258–262. doi: 10.1136/ard.52.4.258. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Must A., Dallal G. E., Dietz W. H. Reference data for obesity: 85th and 95th percentiles of body mass index (wt/ht2) and triceps skinfold thickness. Am J Clin Nutr. 1991 Apr;53(4):839–846. doi: 10.1093/ajcn/53.4.839. [DOI] [PubMed] [Google Scholar]
  24. O'Reilly S. C., Jones A., Muir K. R., Doherty M. Quadriceps weakness in knee osteoarthritis: the effect on pain and disability. Ann Rheum Dis. 1998 Oct;57(10):588–594. doi: 10.1136/ard.57.10.588. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. O'Reilly S. C., Muir K. R., Doherty M. Effectiveness of home exercise on pain and disability from osteoarthritis of the knee: a randomised controlled trial. Ann Rheum Dis. 1999 Jan;58(1):15–19. doi: 10.1136/ard.58.1.15. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Penninx B. W., Guralnik J. M., Ferrucci L., Simonsick E. M., Deeg D. J., Wallace R. B. Depressive symptoms and physical decline in community-dwelling older persons. JAMA. 1998 Jun 3;279(21):1720–1726. doi: 10.1001/jama.279.21.1720. [DOI] [PubMed] [Google Scholar]
  27. Salaffi F., Cavalieri F., Nolli M., Ferraccioli G. Analysis of disability in knee osteoarthritis. Relationship with age and psychological variables but not with radiographic score. J Rheumatol. 1991 Oct;18(10):1581–1586. [PubMed] [Google Scholar]
  28. Simonsick E. M., Maffeo C. E., Rogers S. K., Skinner E. A., Davis D., Guralnik J. M., Fried L. P. Methodology and feasibility of a home-based examination in disabled older women: the Women's Health and Aging Study. J Gerontol A Biol Sci Med Sci. 1997 Sep;52(5):M264–M274. doi: 10.1093/gerona/52a.5.m264. [DOI] [PubMed] [Google Scholar]
  29. Summers M. N., Haley W. E., Reveille J. D., Alarcón G. S. Radiographic assessment and psychologic variables as predictors of pain and functional impairment in osteoarthritis of the knee or hip. Arthritis Rheum. 1988 Feb;31(2):204–209. doi: 10.1002/art.1780310208. [DOI] [PubMed] [Google Scholar]
  30. Tennant A., Fear J., Pickering A., Hillman M., Cutts A., Chamberlain M. A. Prevalence of knee problems in the population aged 55 years and over: identifying the need for knee arthroplasty. BMJ. 1995 May 20;310(6990):1291–1293. doi: 10.1136/bmj.310.6990.1291. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Tinetti M. E., Inouye S. K., Gill T. M., Doucette J. T. Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes. JAMA. 1995 May 3;273(17):1348–1353. [PubMed] [Google Scholar]
  32. Verbrugge L. M., Gates D. M., Ike R. W. Risk factors for disability among U.S. adults with arthritis. J Clin Epidemiol. 1991;44(2):167–182. doi: 10.1016/0895-4356(91)90264-a. [DOI] [PubMed] [Google Scholar]
  33. Yesavage J. A., Brink T. L., Rose T. L., Lum O., Huang V., Adey M., Leirer V. O. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982;17(1):37–49. doi: 10.1016/0022-3956(82)90033-4. [DOI] [PubMed] [Google Scholar]
  34. Young A. Current issues in arthrogenous inhibition. Ann Rheum Dis. 1993 Nov;52(11):829–834. doi: 10.1136/ard.52.11.829. [DOI] [PMC free article] [PubMed] [Google Scholar]

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